Tuberculous pericarditis
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor-In-Chief: Varun Kumar, M.B.B.S.
Overview
The incidence of tuberculosis caused by Mycobacterium tuberculosis and its complications has significantly decreased in developed nations while its still seems to be high in developing countries. About one third of the world population is believed to be infected with tuberculosis(TB)[1]. In 2006 WHO estimated the global prevalence of active TB[2] to be 14.4 million with incidence of 9.2 million. And TB related death accounted for 1.7 million worldwide. One of the important complications of TB is pericarditis which is the inflammation of pericardial sac that encases heart.
Epidemiology and demographics
Tuberculous pericarditis is found in approximately 1-2% of patients with pulmonary tuberculosis[3][4]. It is the most common cause of pericarditis in Africa and other developing countries where TB is a major public health problem[5]. The incidence is increasing rapidly in presence of HIV[6].
In a study at Western Cape Province of South Africa, tuberculous pericarditis was noted in 69.5% of patients who were referred for diagnostic pericardiocentesis and one half of the patients were infected with HIV[7]. In contrast, the incidence of tuberculous pericarditis is 4% in developed countries[8].
Natural history and complications
Tuberculous pericarditis often has a complicated course with worse outcomes. It can lead to pericardial effusion and subsequently, cardiac tamponade which may require urgent intervention including pericardiocentesis. Mortality rate of tuberculous pericarditis in preantibiotic era was 80-90%[9]. Mortality rate currently is 8-17%[10][11] and 17-34% if associated with HIV[12].
Tuberculous pericarditis can also cause heart failure as observed in Eastern Cape and Zimbabwe where it is a common cause, but less common than rheumatic heart disease and more common than hypertensive heart disease and cardiomyopathy[13][14]
Constrictive pericarditis is another complication of tuberculous pericarditis occurring in 30-60% of patients despite prompt antituberculosis treatment and the use of corticosteroids[15][8]
Diagnosis
Tuberculous pericarditis has a variable clinical presentation and should be considered in the evaluation of all cases of pericarditis without a rapidly self-limited course[8].
References
- ↑ Lönnroth K, Raviglione M (2008). "Global epidemiology of tuberculosis: prospects for control". Semin Respir Crit Care Med. 29 (5): 481–91. doi:10.1055/s-0028-1085700. PMID 18810682.
- ↑ WHO. Global Tuberculosis control. WHO/HTM/TB/2008.393. Geneva: World Health Organization; 2008. Available online at http://www.who.int/tb/publications/global_report/2008/en/index.html (Accessed June 27, 2011)
- ↑ Fowler NO (1991). "Tuberculous pericarditis". JAMA. 266 (1): 99–103. PMID 2046135.
- ↑ Larrieu AJ, Tyers GF, Williams EH, Derrick JR (1980). "Recent experience with tuberculous pericarditis". Ann Thorac Surg. 29 (5): 464–8. PMID 7377888.
- ↑ Mayosi BM, Volmink JA, Commerford PJ. Pericardial disease: an evidence-based approach to diagnosis and treatment. In: Yusuf S, Cairns JA, Camm AJ, Fallen BJ, eds. Evidence-Based Cardiology. 2nd ed. London: BMJ Books; 2003: 735–748.
- ↑ Cegielski JP, Ramiya K, Lallinger GJ, Mtulia IA, Mbaga IM (1990). "Pericardial disease and human immunodeficiency virus in Dar es Salaam, Tanzania". Lancet. 335 (8683): 209–12. PMID 1967676.
- ↑ Reuter H, Burgess LJ, Doubell AF (2005). "Epidemiology of pericardial effusions at a large academic hospital in South Africa". Epidemiol Infect. 133 (3): 393–9. PMC 2870262. PMID 15962545.
- ↑ 8.0 8.1 8.2 Sagristà-Sauleda J, Permanyer-Miralda G, Soler-Soler J (1988). "Tuberculous pericarditis: ten year experience with a prospective protocol for diagnosis and treatment". J Am Coll Cardiol. 11 (4): 724–8. PMID 3351140.
- ↑ Harvey AM, Whitehill MR. Tuberculous pericarditis. Medicine. 1937; 16: 45–94
- ↑ Desai HN (1979). "Tuberculous pericarditis. A review of 100 cases". S Afr Med J. 55 (22): 877–80. PMID 472922.
- ↑ Bhan GL (1980). "Tuberculous pericarditis". J Infect. 2 (4): 360–4. PMID 7185934.
- ↑ Hakim JG, Ternouth I, Mushangi E, Siziya S, Robertson V, Malin A (2000). "Double blind randomised placebo controlled trial of adjunctive prednisolone in the treatment of effusive tuberculous pericarditis in HIV seropositive patients". Heart. 84 (2): 183–8. PMC 1760932. PMID 10908256.
- ↑ Strang JI (1984). "Tuberculous pericarditis in Transkei". Clin Cardiol. 7 (12): 667–70. PMID 6509811.
- ↑ Hakim JG, Manyemba J (1998). "Cardiac disease distribution among patients referred for echocardiography in Harare, Zimbabwe". Cent Afr J Med. 44 (6): 140–4. PMID 9810393.
- ↑ SCHRIRE V (1959). "Experience with pericarditis at Groote Schuur Hospital, Cape Town: an analysis of one hundred and sixty cases studied over a six-year period". S Afr Med J. 33: 810–7. PMID 14443596.